INTRODUCING INTEGRATED LEARNING PROGRAM IN NERVOUS SYSTEM FOR FIRST

YEAR UNDERGRADUATES : EXPERIENCE FROM INDIAN MEDICAL SCHOOL

SARMISHTHA GHOSH, HIMANSHU PANDYA,SK SINGH, RAKSHA BHAT, N.HARIDAS,

HH AGRAVATPRAMUKHSWAMI MEDICAL COLLEGE

KARAMSAD, GUJARAT 388325

INTRODUCTION• Dividing medicine into disciplines is an artificial

construct• The real world of medical practice is transdisciplinary

in a large part.• Learning facts become easier when they are learnt in

a relevant and meaningful way • GPEP report, GMC[UK] recommendations stress the

need for greater integration of subjects in medical curriculum

• Medical Council of India recommends both horizontal and vertical integration in undergraduate medical education

• Modular approach has also been recommended alongwith incorporation of problem based learning.

OBJECTIVES

Curriculum Committee and Basic Science faculty of the Pramukhswami Medical College designed an Integrated Learning Program for the Central Nervous System for the First year MBBS batch 2006-2007 students

• To develop and implement an integrated module on Central Nervous System in basic sciences

• To focus on integrated learning using multiple teaching learning modalities

• To demonstrate the feasibility and importance of an integrated learning program in preclinical phase of medical education in a college following traditional medical curriculum

METHODOLOGY

Series of meetings

Formal meeting with all faculty of basic Science

Departments

Identification of Learning Objectives

on CNS

Content delivery

1. Didactic Lectures

2. Interactive Lectures

3. Case Based Learning [CBL]

4. Group Seminars by students

5. Dissection/ Demonstration / Practical Laboratory exercises

6. Hospital Visits with patient contact

Histology, Embryology

DURATION OF THE MODULE - 6 WEEK

TOTAL NUMBER OF HOURS : 199

END OF MODULE INTEGRATED ASSESSMENT ON ANATOMY, PHYSIOLOGY & BIOCHEMISTRY

OF CNS IN A CASE VIGNETTE FORMAT

Evaluation of the program by a structured questionnaire

STUDENTS BASIC SCIENCE FACULTY

Distribution of hours to Anatomy, Physiology and Biochemistry in ILP[CNS]

Number of total hours =199

Anatomy50%Physiology

47%

Biochemistry3%

Proportion of various teaching learning methods incorporated into the Integrated Learning Program

on Central Nervous System [ILP-CNS]

Dissection28%

CBL8%

Prac/ Hosp visits9%

Demo[only]5%

Didactic Lec - Interaction

31%

Didactic Lec+Interacti

on12%Seminar

3%

Self study4%

RESPONSES OF THE STUDENTS

Overall Rating of Integrated Learning Program on Central Nervous System [ILP-CNS] with regard to understanding, appreciation and application of

basic knowledge of nervous system to health and disease; N=98

0

5

10

15

20

25

30

35

40

Understanding Appreciation Application

type of response

nu

mb

er o

f st

ud

ents

Poor

Satis

Good

Very Good

Excellent

NR

RATING OF INDIVIDUAL TEACHING/LEARNING METHODS BY THE STUDENTS

Poor

Satis

Good

Very Good

Excellent

No resp

Poor

Satis

Good

Very Good

Excellent

No resp

PoorSatis

Good

Very Good

Excellent

No resp

Poor

Satis

Good

Very Good

Excellent

No resp0

5

10

15

20

25

30

35

40

45

Poor Satis Good Very Good Excellent No respRating

Num

ber

of R

esponse

s

DL [-I] DL [+I] Seminar CBL

RATING OF INDIVIDUAL TEACHING/LEARNING METHODS BY THE STUDENTS

Poor

Satis Good

Very GoodExcellent

No resp

Poor

Satis

Good

Very Good

No respPoor

Satis

Good

Very Good

Excellent

No resp

Excellent

0

5

10

15

20

25

30

35

40

45

Rating

Num

ber of R

esponses

Demo[only]Practicals Hosp visits

RESPONSES OF THE BASIC SCIENCE FACULTY

Proportion of Faculty in Basic Sciences according to designation and departmentwise who

participated in the ILP-CNS; N=15

Prof27%

Addl Prof 13%

Assoc Prof13%

Assistant Prof27%

Lecturer/ Tutor20%

Anatomy40%

Physiology40%

Biochemistry20%

Likings and Dislikings of Basic Science faculty regarding different aspects of ILP-CNS

0

2

4

6

8

10

12

1 2 3 4

Items in questionnaire

Nu

mb

er o

f re

sp

on

se

s

Liked

Did not like

Uncertain

No Resp

1.Interdepartmental discussions amongst basic science faculty

2. Interdepartmental discussions amongst basic and clinical science faculty

3. Integrated assessment of Students of Phase I

4. Coordination & Group activity towards implementation of ILP

Level of Satisfaction amongst Faculty of Basic Sciences towards different aspects of Integrated

Learning Program ILP-CNS,N=14

0

2

4

6

8

10

12

14

Framing ofTimetable

Delivery ofContent

Assessmentof Students

Evaluation ofProgram

Items for which satisfaction was evaluated

Nu

mb

er o

f re

spo

nse

s

Great extent

Some extent

Not at all

No Resp

Recommendation by Basic Science Faculty for introduction of Integrated Learning Program in Phase I

of Undergraduate Medical Course

0

1

2

3

4

5

6

7

8

9

1

Nu

mb

er

of

Re

sp

on

se

s Strongly

To someextent

Not at all

Noresponse

Recommendations

Opinions of Basic Science Faculty regarding various aspects of Integrated Learning Program; N=14

0

1

2

3

4

5

6

7

8

9

1 2 3 4

Items in Questionnaire

Num

ber of R

esponses

Strongly Agree

Agree

Strongly Disagree

Disagree

Uncertain

1. ILP has improved the understanding & application of basic science knowledge of first year students in health & disease

2. ILP will help the students perform better in University exam [Oct 2007]

3.ILP will help students to perform better in later days of their clinical exposure

4. The concept of ILP is interesting

Opinions of basic Science Faculty regarding ILP - II

0

1

2

3

4

5

6

7

8

5 6 7 8

Items in Questionnaire

Responses

Strongly AgreeAgreeStrongly DisagreeDisagreeUncertain

5. ILP has helped me develop positive attitude towards medical education

6. I developed better interpersonal skills in terms of listening, giving, discussing, receiving criticism

7. ILP requires too much of time and is not worth all the effort

8. ILP helped me develop the ability to accept and work with faculty of different nature and subject background

ILP- better performance in University Phase I exam.

Yes43%

No21%

Uncertain36% Yes

36%

No60%

Uncertain4%

FACULTY OPINION STUDENT OPINION

ILP - better performance in later days of clinical exposure

Yes78%

No16%

Uncertain6%

No0%

Uncertain14%

Yes86%

FACULTY OPINION STUDENT OPINION

Conclusions• It is possible to introduce Integrated Learning Program

in Phase I of a conventional medical curriculum• A lot of cooperation and coordination between

departments is required to make such a program a success.

• Majority of students rated the program as good to very good with reference to appreciation, understanding and application of basic science knowledge in health and disease

• Different teaching learning methods were rated differently by the students.

• Lectures with interaction, group seminars, hospital visits with patient contact as well as hands on practicals were more appreciated as compared to other methods.

• Faculty expressed overall satisfaction towards ILP[CNS] though they showed concern over the implementation of ILP approach for all systems in basic sciences

• The interaction amongst the basic science faculty and between basic and clinical science faculty resulted in cooperation and collaboration which is reflective of attitudinal change in faculty

• Considerable success in the implementation of this program for the first time in our Institution laid the foundation of adopting ILP in other systems in Phase I as well as for Phase II and Phase III.

References• Smith SR, Toward an Integrated Medical Curriculum. Medicine and Health

Rhode Island. Aug 2005. FindArticles.com available at http://findarticles.com/p/articles/mi_qa4100/is_200508/ai_n1489557, accessed on 10 October 2007.

• Association of American Medical Colleges. Physicians for the Twenty-first Century: Report of the project panel on the General Professional Education of the Physicians and college Preparation for Medicine. J Med Educ 1984; 59. Part 2:1-208.

• Anderson MB, Swanson AG. Educating medical students- ACME-TRI report with supplements. Acad Med, 1993; 68(suppl): S1-46.

• General Medical Council Tomorrow's doctors:Recommendations on Undergraduate medical education. London : General Medical Council 1993.

• Medical Council of India. Salient features of Regulations on Graduate Medical Education, 1997 Available at :http://www.mciindia.org/know/rules/rules_mbbs.htm, accessed Oct 08, 2007

• Pring R. Curriculum integration, p 265-72. In : Hooper, R ed. The Curriculum : Context Design and Developemnt Education. Edinburgh : Oliver & Boyd, 1970

• Shimura, T, Takumi A, Shimizu K,Miyashita S,Adachi K,Teramoto A,Implementation of Integrated Medical Curriculum in Japanese Medical Schools, J Nippo Med Sch 2004; 71:11-16,

• Jamkar A,Yemul V, Singh G. Integrated teaching programme with student- centered case- based learning.Medical Education, 2006; 40:466-467.

Acknowledgement

• Mr. Sandeep Desai, CEO, HM Patel Center for Medical Care & Education, Karamsad for initiating and driving the process

• All faculty members of the departments of Anatomy , Physiology & Biochemistry who took special interest in planning and implementation of timetable and then gave a feedback at the end of the program

• The students of batch 2006-2007 who participated in the program enthusiatically in spite of hurdles and gave a constructive feedback at the end of the program